"Sandwich Technique" via a Right Ventricle Incision to Repair Postinfarction Ventricular Septal Defects.

BACKGROUND

Residual shunting and mortality are problems associated with the current surgical repair techniques for postinfarction ventricular septal defects (VSD). We developed the "sandwich technique" via a right ventricle incision and assessed the surgical outcome of 13 years of experience with this technique.

METHODS

Between June 2001 and March 2013, 25 consecutive patients with postinfarction VSD underwent surgical repair using this technique. This technique includes the following: Application of direct ultrasonography to the right ventricular (RV) wall enables the surgeon to visualize the lesion, perform an appropriate incision into the RV, and perform a trabecular resection. One patch is placed on the left ventricular (LV) side and the other on the RV side of the VSD. The VSD is sealed with gelatin-resorcin-formalin (GRF) glue between the two patches.

RESULTS

Thirty-day mortality was 0% (0/25 case). A postoperative major shunt occurred in three patients (12%, 3/25) and two of them required reoperation (8%, 2/25). Hospital mortality was 28% (seven patients). Mean follow-up period was 4.2 ± 3.7 years. The overall survival at one, five, and 10 years was 71 ± 9%, 65 ± 10%, and 56 ± 12%, respectively. There was no cardiac death during follow-up in the patients who survived for six months after the surgery. No tissue degeneration related to GRF glue was noted.

CONCLUSIONS

The "sandwich technique" via a right ventricle incision results in a low incidence of postoperative leak and good short- and mid-term survival.